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Citation and License

BMC Public Health 2013, 13:442
doi:10.1186/1471-2458-13-442

Published: 4 May 2013

Abstract

Background

Lesbians have low rates of cervical cancer screening, even though they are at risk
of developing the disease. The aim of this study was to examine cervical cancer screening
behaviors in a national sample of lesbians.

Methods

A standardized internet survey was sent to 3,000 self-identified lesbians to assess
cervical cancer screening behaviors and barriers to screening. The sample consisted
of 1,006 respondents.

Results

Sixty-two percent of the weighted sample of respondents were routine screeners. Lack
of a physician referral (17.5%) and lack of a physician (17.3%) were the most commonly-cited
top reasons for lack of screening. Adjusting for age, education, relationship status,
employments status, and insurance status, women who had disclosed their sexual orientation
to their primary care physician (adjusted odds ratio [OR] 2.84 [95% confidence interval
1.82-4.45]) or gynecologist (OR 2.30 [1.33-3.96]) had greater odds of routine screening
than those who did not. Those who knew that lack of Pap testing is a risk factor for
cervical cancer were also more likely to be routine screeners (OR 1.95 [1.30-2.91]),
although no association with screening was apparent for women who had more knowledge
of general cervical cancer risk factors. Physician recommendation appeared to be a
potent determinant of regular screening behavior. Routine screeners perceived more
benefits and fewer barriers to screening, as well as higher susceptibility to cervical
cancer.

Conclusions

Some women who identify as lesbian are at a potentially elevated risk of cervical
cancer because they are not routinely screened. Evidence-based interventions should
be developed to address critical health beliefs that undermine participation in screening.
Given the value placed on physician recommendation, patient-provider communication
may serve as the optimal focus of effective intervention.